Spilt of S2
Physiologic Split S2 This happens during inspiration when increased venous return to the right side of the heart delays the closure of the pulmonic valve (major effect), and decreased return to the left side of the heart hastens the closure of the aortic valve (minor effect), thereby further separating A2 and P2. Split is best commented in Pulmonary area Abnormal spilts different types of split S2 can be associated with medical conditions: Wide splitting : seen in conditions that delay RV emptying (pulmonic stenosis, right bundle branch block). Delay in RV emptying causes delayed pulmonic sound (regardless of breath); it is an exaggeration of normal splitting sounds Split during expiration : Reverse splitting (paradoxical splitting) indicates pathology due to delay of aortic valve closing. Aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker could all cause a reverse splitting of the second heart sound. Here P2 is early and A2 is